This article presents a framework for evaluating long-term care policies and programs to
determine how well community-based programs benefit the older adult population. Equity,
accessibility, quality, and efficiency are identified as core criteria for implementing and
evaluating long-term care policy. Special problems with conducting process and/or outcome
evaluation of community-based programs are noted, and findings of evaluation research on
community-based health care programs are reviewed. Most previous research indicates that
community-based health programs for older adults are not a substitute for institutional care and
do not reduce either informal caregiving or ambulatory medical services. The article concludes
with policy implications.
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References
1.
Blank, R.H. (1988). Rationing medicine.New York: Columbia University Press.
2.
Breslau, N. (1982). Continuity re-examined: Differential impact on satisfaction with medical care for disabled and normal childrenMedical Care, 20, 347-359.
3.
Brook, R.H., & Davies-Avery, A. (1977). A tradeoff between cost and quality in ambulatory care. Quality Review Bulletin, 3, 4-7.
4.
Brook, R.H., & Lohr, K.N. (1986). Will we need to ration effective medical care?Issues in Science and Technology, 3, 68-77.
5.
Capitman, J.A. (1986). Community-based long-term care models, target groups, and impacts on service use. Gerontologist , 26, 389-397.
6.
Clark, R., Maddox, G., Schrimper, R.A., & Sumner, D. (1984). Inflation and economic well-being of the elderly.Baltimore, MD: Johns Hopkins University Press.
7.
Donabedian, A. (1980). Explorations m quality assessment and monitoring: Vol. 1. The definition of quality and approach to its assessment.Ann Arbor, MI: Health Administration Press.
8.
Drummond, M.F., Stoddart, G.L., & Torrance, G.W. (1987). Methods for the economic evaluation of health care programs.Oxford: Oxford University Press.
9.
Garfinkel, S., Corder, L., & Dobson, A. (1986). Health services utilization in the U.S. population by health insurance coverage. National Medical Care Utilization and Expenditure Survey (Series B, Report No. 9). Washington, DC: Health Care Financing Administration.
10.
Gray, B. H., & Field, M. J. (Eds.). (1989). Controlling costs and changing patient care? The role of utilization management.Washington,DC: National Academy Press.
11.
Greenberg, J., & Ginn, A. (1979). A multivariate analysis of the predictors of long-term care placement. Home Health Care Services Quarterly , 1, 75-99.
12.
Haber, D. (1989). Health care for an aging society.New York: Hemisphere.
13.
Hedrick, S.C., & Inui, T.S. (1986). Effectiveness and cost of home care: An information synthesisHealth Services Research, 20, 851-880.
14.
Hughes, S. (1985). Apples and oranges: A review of community-based long-term care demonstrations. Health Services Research , 20461-488.
15.
Hughes, S.L., Cummings, J., Weaver, F., Manheim, L., Conrad, K.J., & Nash, K. (1990). A randomized trial of Veterans Administration home care for severely disabled veterans. Medical Care , 28, 1867-1868.
16.
Jirka, F.J., Jr. (1984). Three major challenges: Quality, cost, and balance . Journal of the American Medical Association , 251, 1867-1868.
17.
Kane, R.A., & Kane, R.L. (1981). Assessing the elderly: A practical guide to measurement.Lexington, MA: Lexington Books.
Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., & Jane, M.W. (1963). Studies of illness in the aged, the index of ADL: A standardized measure of biological and psychological function. Journal of the American Medical Association, 185, 914-919.
20.
Kemper, P. (1988). The evaluation of the national long-term care demonstration: Overview of findings. Health Services Research , 23, 161-174.
21.
Lawton, M.P., & Brody, E. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist , 9, 179-186.
22.
Lawton, M.P., & Nahemow, L. (1973). Ecology and the aging process. In C. Eisdorfer & M. P. Lawton (Eds.), The psychology of adult development and aging (pp. 619-674). Washington, DC: American Psychological Association.
23.
Mahoney, F.I., & Barthel, D.W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 16-64.
24.
Markson, E., Steel, K., & Kane, E. (1983). Administratively necessary daysGerontologist, 23, 486-492.
25.
Mathematica Policy Research. (1986). The evaluation of the national long term care demonstration : Final Report (100-80-0157). Plainsboro, NJ: Department of Health and Human Services.
26.
Miller, M.K., & Stokes, C.S. (1978). Health status, health resources, and consolidated structural parameters: Implications for public health care policy. Journal of Health and Social Behavior, 19, 263-279.
27.
Roemer, M. (1961). Bed supply and hospital utilization. Hospitals, 48, 51-56.
28.
Roos, L.L., Roos, N.P., Gilbert, P., & Nicol, J.P. (1980). Continuity of care: Does it contribute to quality of care?Medical Care, 18, 174-184.
29.
Rosow, I., & Breslau, N. (1966). A Guttman Health Scale for the aged. Journal of Gerontology, 21, 556-559.
30.
Rossiter, L.F., Nelson, L.M., & Adamache, K.W. (1988). Services use and costs of Medicare beneficiaries in risk-based HMOs and CMPs: Some interim results from the national Medicare competition evaluation. American Journal of Public Health, 78 , 937-943.
31.
Ruchlin, H.S., Sinkel, M.L., & McCarthy, E.G. (1982). The efficacy of second-opinion consultation programs: A cost benefit perspective. Medical Care, 20, 3-19.
32.
Schieber, G.J., & Poullier, J.P. (1989). Overview of international comparisons of health care expenditures. Health Care Financing Review (Annual Supplement), 1-7.
33.
Seidl, F.W., Applebaum, R., Austin, C., & Mahoney, K. (1983). Delivering in-home services to the aged and disabled.Lexington, MA: Lexington Books.
34.
Soldo, B.J., & Manton, K.G. (1985). Changes in the health status and service needs of the oldest old: Current patterns and future trends. Milbank Memorial Fund Quarterly, 63, 286-323.
35.
Stewart, A.L., Ware, J., Brook, R.H., & Davies-Avery, A. (1978). Conceptualization and measurement of health for adults in the health insurance study: Vol. 2. Physical health in terms of functioning.Santa Monica, CA: RAND.
36.
U.S. General Accounting Office. (1979). Entering a nursing home: Costly implications for Medicaid and the elderly.Washington, DC: U.S. Government Printing Office.
37.
U.S. General Accounting Office. (1986). Evaluation of the impact of Medicare prospective payment plan on post-hospital long-term care services. Washington, DC: U.S. Government Printing Office.
38.
U.S. House Select Committee on Aging. (1989 ). Health care costs for America's elderly, 1977-1988. Washington, DC: U.S. Government Printing Office.
39.
U.S. Senate Special Committee on Aging. (1985 ). The cost of caring for the chronically ill: The case for insurance.Washington, DC: U.S. Government Printing Office.
40.
Veney, J.E., & Kaluzny, A.D. (1984). Evaluation and decision making for health services programs.Englewood Cliffs, NJ: Prentice-Hall.
41.
Wan, T.T.H. (1986). Evaluation research in long-term care: Scope and methodology. Research on Aging, 8, 559-585.
42.
Wan, T.T.H. (1987). Functionally disabled elderly: Health status, social support, and use of health services. Research on Aging, 9, 61-78.
43.
Wan, T.T.H., & Weissert, W.G. (1981). Social support networks, patient status, and institutionalization. Research on Aging , 3, 249-256.
44.
Wan, T.T.H., Weissert, W.G., & Livieratos, B. (1980). Geriatric day care and homemaker services: An experimental studyJournal of Gerontology , 35, 256-274.
45.
Ware, J., Jr. (1986). The assessment of health status. In L. H. Aiken & D. Mechanic (Eds.), Applications of Social Science to Clinical Medicine and Health Policy (pp. 204-228). New Brunswick, NJ: Rutgers University Press.
46.
Weissert, W.G. (1985). Seven reasons why it is so difficult to make community based long-term care cost-effective. Health Services Research , 20, 423-433.
47.
Weissert, W.G., & Cready, C.M. (1988). Determinants of hospital and nursing home placement delays: A pilot studyHealth Services Research , 23, 619-647.
48.
Weissert, W.G., Cready, C.M., & Pawelak, J.E. (1988). The past and future of home and community based long-term care. Milbank Memorial Fund Quarterly , 66, 309-388.
49.
Weissert, W.G., & Scanlon, W. (1985). Determinants of nursing home discharge status . Medical Care, 23, 333-343
50.
White, L.L., & Chirikos, T.N. (1988). Measuring hospital competition . Medical Care, 26, 256-262.
51.
Wolinsky, F.D., Coe, R.M., Miller, D.K., & Prendergast, J.M. (1984). Measurement of global and functional dimensions of health status in the elderly. Journal of Gerontology, 39 , 88-92.
